Medicaid’s Role in West Virginia

Medicaid in West Virginia

  • Over 564,000 people in West Virginia are covered by Medicaid (29% of the population), making West Virginia the state with the highest share of its population enrolled in Medicaid.
  • Three-fourths (74%) of enrollees are children and adults, but nearly two-thirds (61%) of the state’s Medicaid spending is for the elderly and people with disabilities.
  • 87,200 (22%) of West Virginia’s Medicare enrollees are also covered by Medicaid, which accounts for over a third (36%) of Medicaid spending.
  • 53% of all children in West Virginia are covered by Medicaid, including 56% of children with special health care needs.
  • 76% of nursing home residents in West Virginia are covered by Medicaid and 41% of Medicaid long-term care spending is for nursing home care. Medicare beneficiaries rely on Medicaid for assistance with services not covered by Medicare, particularly long-term care.
  • Nearly half (46%) of people in West Virginia live in rural areas. People who live in rural areas are more likely to be dependent on Medicaid.
  • West Virginia has the second lowest per capita income in the country and therefore one of the highest federal Medicaid matching assistance percentage (FMAP) at 73%. For every $1 spent by the state, the Federal government matches $2.55. Over three-fourths (79%) of all federal funds West Virginia receives are for Medicaid. In Calendar Year 2017, the federal match rate for the Medicaid expansion population is 95%.

What is at Risk under a Per Capita Cap?

  • Capping Medicaid funding would reduce the federal assistance for West Virginia to maintain its current Medicaid program.
    • Under the Better Care Reconciliation Act of 2017 (BCRA), to maintain its current Medicaid program, West Virginia would have to make up $3.4 billion in loss of federal funds between 2020-2029, including $1.5 billion for the phase-out of the enhanced match for the ACA expansion and $1.9 billion for the per enrollee cap on all groups.
    • If West Virginia dropped the Medicaid expansion in response to the loss of enhanced federal financing, the state would forgo an additional $7.6 billion over the 2020-2029 period, and by 2029, 227,000 West Virginians estimated to be covered in the expansion group would lose Medicaid coverage.
  • Capping federal Medicaid funding could jeopardize Medicaid programs designed to improve quality of life and access to long-term care for people with disabilities. 20% of West Virginia non-institutionalized population reported a disability, the highest reported percentage compared to a U.S. average of 13%.
  • West Virginia’s population faces multiple high health needs and limited access to care. Reducing federal funds through a per capita cap or block grant would limit West Virginia’s ability to respond to public health crises such as the opioid epidemic, HIV, or Zika.
    • West Virginia had the highest opioid death rate in the country in 2015 (36 deaths per 100,000 population). From 2013 to 2015, West Virginia’s opioid death rate grew by 29%. West Virginia also has the highest obesity rate in the country (71.1%).
    • West Virginia ranks 43 in overall health status. In addition, 30% of people in West Virginia live in a health professional shortage area for primary care and have limited access to the services they need while 14% of adults report not seeing a doctor due to cost.

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